The 13th Annual SWC Summer Seminar Registration Full Name * Credentials * Certification Number * Email Address * Employer * If not currently employed as an athletic trainer, please write "N/A" School Covered (if applicable) * If you are not employed at a school, please write "N/A" Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number * (###) ### #### Emergency Contact Name * In case of an emergency, please write down an emergency contact. Please do not write "Self" Emergency Contact Relationship * Emergency Contact Phone Number * (###) ### #### Preferred Payment Option * Cash or checks may be sent to Attn: Aaron Kremmel, 2555 West Blvd, Belleville, IL 62221. Checks can be made payable to Belleville East High School Cash or Check in Mail Cash or Check at the Door Comments or Questions Thank you for registering for our 12th Annual SWC Summer Seminar! If you would like a formal receipt, please don’t hesitate to reach out to us at swcatcs@gmail.com. Form not working? Contact us at swcatcs@gmail.com!
